Salmonella Montevideo Outbreak in the Offing – Daniele Salami

Since it is Friday, expect a recall tonight (or over the weekend) from FSIS on a meat-like product (Daniele Salami) contaminated with Salmonella Montevideo that has sickened over 200, with some 30 hospitalized in several states. The outbreak has been ongoing for months.

The term Salmonella refers to a group or family of bacteria that has been known to cause illness in humans for over 100 years. Salmonella bacteria are usually transmitted to humans by eating foods contaminated with animal feces or foods that have been handled by infected food workers. Thoroughly cooking contaminated foods kills Salmonella. People infected with Salmonella have diarrhea, fever, and abdominal cramps occurring 12-72 hours after exposure. Illness usually lasts 4-7 days. Most people recover without treatment but serious illness can occur requiring hospitalization and even resulting in death.

The family of Salmonella bacteria is distinguishable by antigenic response. Scientists have identified more than 2500 serotypes of Salmonella. Salmonella serotype typhimurium is the most common serotype in the United States. Salmonella serotype Montevideo is one of the ten most common serotypes, with 19,928 case patients reported to the CDC in the thirty-year period, 1968 to 1998. Outbreaks of Salmonella Montevideo are not uncommon. Outbreaks have occurred in food served by an unlicensed caterer in Virginia (2009), pistachio nuts (2009), barbequed pork (2007 and in fast food roast beef sandwiches (2006).

Aggie Jennings of rural McLean County catered three events (2 weddings, 1 reunion) in mid-June that led to three separate outbreaks of Salmonella Montevideo. Ms. Jennings’ catering operation was not licensed. Salmonella Montevideo is a strain that is associated with baby chickens, and Ms. Jennings raised chickens. The Salmonella strain matched a strain associated with a chicken hatchery in Iowa. At one catered event, consumption of the potato salad was associated with illness, however no food samples tested positive for salmonella. At another event, ground beef that had been served as taco meat was associated with illness and tested positive for the presence of Salmonella Montevideo. At the third event, shredded beef and noodle salad tested positive for Salmonella.

April 09 Setton Pistachio of Terra Bella, Inc., 2009

• Organism: Salmonella Montevideo
• Vehicle: Nuts, Pistachios

Multiple strains of Salmonella bacteria were detected in pistachios (roasted shelled, roasted in-shell, raw) that were sold and subsequently distributed widely throughout the United States. The pistachios were repackaged and sold under many names. The Food and Drug Administration provided the Centers for Disease Control with the genetic fingerprints of the Salmonella strains that had been found in the pistachios. Some of the genetic fingerprints matched Salmonella strains from recently ill persons, but these illness could not be proven to be due to consumption of pistachios. One patient in Connecticut who had been infected with a Salmonella strain with a matching genetic fingerprint reported eating a pistachio-containing product.

January 07 Georgia BBQ Smoked Pork 2007

• Organism: Salmonella Montevideo
• Vehicle: Pork, Smoked

The Statesboro area health department in March identified an outbreak of Salmonella Montevideo. The first cases dated back to January, but only when genetic tests showed all the cases were infected with the same strain of S. Montevideo did an investigation begin in earnest. Investigators performed a case-control study using neighborhood controls. This study showed that those who ate at a local restaurant were 52 times more likely to have been infected. This finding led to an environmental investigation of the restaurant where multiple violations of health codes were noted. The restaurant voluntarily closed to remodel and reassess its policies. It reopened and had no more cases of salmonellosis associated with it.

January 07 Live Poultry Contact 2007

• Organism: Salmonella Montevideo
• Vehicle: Animal Contact

In June, two persons from Minnesota developed Salmonella Montevideo after being in contact with baby chicks that had originated from the same Iowa hatchery. In September, seven additional people became ill in North Dakota with the same strain of Salmonella Montevideo. A subsequent nationwide investigation identified a total of 65 matching Salmonella Montevideo isolates; there was a likely association with exposure to live poultry originating from the same Iowa hatchery. A separate outbreak of a different strain of Salmonella Montevideo occurred throughout 2007. A total of 64 cases were identified. These illnesses were linked to contact with live poultry that originated from hatcheries in New Mexico and Ohio.

August 06 Arby’s Roast Beef Sandwich 2006

• Organism: Salmonella Montevideo
• Vehicle: Sandwiches, Roast Beef

An Arby’s Restaurant in Valdosta, Georgia, was implicated in an outbreak of Salmonella in August. Five cases were reported to the health department, prompting an investigation. A food history questionnaire showed a common exposure to the roast beef sandwich. The restaurant was inspected and found to be using a new meat slicer, which tested positive for the outbreak strain of Salmonella Montevideo.

January 95 Carne Seca or Beef Jerky 1995

• Organism: Salmonella Montevideo
• Vehicle: Beef, Beef Jerky

A locally produced beef jerky, or carne seca, was implicated in an outbreak of Salmonella. Three different serotypes of Salmonella were isolated from the stools of ill persons and from the beef jerky. The processor never measured drying temperatures during production to prevent bacterial growth. In addition, jerky was placed in uncovered plastic tubs for direct sale to the public. Salmonella was not found in the production facility.

Salmonella Complications

While a vast majority of Salmonella infections are self-resolving, there are some unlucky individuals who will continue to suffer long-term complications. However, these complications can include bacteremia, irritable bowel syndrome (IBS) and Reiter’s syndrome.

A. Bacteremia

Bacteremia is characterized by infection of tissues surrounding the brain and spinal cord (meningitis) and infection within the bloodstream (sepsis). This condition occurs when Salmonella enter and circulate within an infected individual’s bloodstream, and is accompanied by few symptoms (Mayo Clinic, 2007, April 12).

B. Irritable Bowel Syndrome

The normal response to infection, such as vomiting and diarrhea, is protective and beneficial. However, in about 10% of patients these protective changes persist and may contribute to the development of post-infective irritable bowel syndrome, which may persist for many years. New insights into the pathogenesis of this condition suggest novel, effective ways of treatment. (Hosp Med. 2003 May; 64(5): 270-4.)

C. Reiter’s Syndrome

Reiter’s syndrome, which includes and is sometimes, referred to as “reactive arthritis” is an uncommon, but debilitating, result of a Salmonella infection. Reiter’s syndrome is a disorder that causes at least two of three seemingly unrelated symptoms: reactive arthritis, eye irritation, and urinary tract infection (Hill Gaston & Lillicrap, 2003). The reactive arthritis associated with Reiter’s develops when a person eats food that has been tainted with bacteria. Reactive arthritis is characterized by the inflammation of one or more joints following an infection localized in another portion of the body, commonly the gastrointestinal tract. The symptoms of Reiter’s Syndrome usually occur between one and three weeks after the infection.

The three most common symptoms of Reiter’s syndrome are arthritis, eye irritation, and urinary tract symptoms. The arthritis associated with Reiter’s syndrome typically affects the knees, ankles, and feet, causing pain and swelling. Wrists, fingers and other joints can be affected, though with less frequency. Patients with Reiter’s syndrome commonly develop inflammation where the tendon attaches to the bone, a condition called enthesopathy. Some patients with Reiter’s syndrome also develop heel spurs, bony growths in the heel that cause chronic or long-lasting foot pain. Arthritis from Reiter’s syndrome can also affect the joints of the back and cause spondylitis, inflammation of the vertebrae in the spinal column. The duration of reactive arthritis symptoms can vary greatly. Most of the literature suggests that the majority of patients recover within a year. The condition, can, however, be permanent. One study found nearly 50 percent of patients with post dysenteric reactive arthritis continued to have symptoms roughly one year after onset (Inman, et al., 1998).

The involvement of the eye in Reiter’s syndrome is most commonly manifested as conjunctivitis, inflammation of the mucous membrane that covers the eyeball, or uveitis, an inflammation of the inner eye. Conjunctivitis and uveitis can cause redness of the eyes, eye pain and irritation, and blurred vision.

The third site for Reiter’s syndrome symptoms is the urogenital tract. This includes the prostate, urethra, and penis in men and the fallopian tubes, uterus, and vagina in women. Men may notice an increased need to urinate, a burning sensation when urinating, and a discharge from the penis. Some men also develop prostatitis. Symptoms of prostatitis include fever, chills, increased need to urinate, and a burning sensation when urinating.

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About Bill Marler

Bill Marler is an accomplished personal injury and products liability attorney. He began litigating foodborne illness cases in 1993, when he represented Brianne Kiner, the most seriously injured survivor of the Jack in the Box E. coli O157:H7 outbreak.